<div id="invest_table">
    <div class="main">
        <h4>请填写申请表格</h4>
        <div class="form_component minus_margin radius">
            <label class="border bgColor121222">申请人</label>
            <div class="ipt_area">
                <input class="white_border placeholder_text_999999" type="text" placeholder="请填写申请人姓名" ng-model='applyName'>
            </div>
            <div class="star">*</div>
        </div>
        
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">执业证号</label>
	        <div class="ipt_area">
	            <input class="white_border placeholder_text_999999" type="tel" placeholder="请填写律师执业证号" ng-model='practiceNo'>
	        </div>
	        <div class="star">*</div>
	    </div>
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">律所名称</label>
	        <div class="ipt_area">
	            <input class="white_border placeholder_text_999999" type="text" placeholder="请填写律所名称" ng-model='lawyerAreaName'>
	        </div>
	        <div class="star">*</div>
	    </div>
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">联系手机号</label>
	        <div class="ipt_area">
	            <input class="white_border placeholder_text_999999" type="tel" placeholder="请填写申请人联系方式" maxlength='11' ng-model='telNo'>
	        </div>
	        <div class="star">*</div>
	    </div>
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">联系地址</label>
	        <div class="ipt_area">
	            <div class="wrapper">
	                <select id="province" ng-model="provinceName" ng-options="o.province for o in provinceData" ng-change="clickCity(provinceName,'0')">
	                    <option value="">选择省</option>
	                </select>
	                <span class="triangle"></span>
	            </div>
	            <div class="wrapper">
	                <select id="city" ng-model="cityName" ng-options="o.city for o in cityData" ng-change="clickArea(cityName,'0')">
	                    <option value="">选择市</option>
	                </select>
	                <span class="triangle"></span>
	            </div>
	            <div class="wrapper">
	                <select id="county" ng-model="districtName" ng-options="o.district for o in districtData">
	                    <option value="">选择区县</option>
	                </select>
	                <span class="triangle"></span>
	            </div>
	        </div>
	        <div class="star">*</div>
	    </div>
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">详细地址</label>
	        <div class="ipt_area">
	            <input class="white_border placeholder_text_999999" type="text" placeholder="请填写详细地址" ng-model='detailAddr'>
	        </div>
	        <div class="star">*</div>
	    </div>
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">原告名称</label>
	        <div class="ipt_area">
	            <input class="white_border placeholder_text_999999" type="text" placeholder="请填写原告名称" ng-model='prosecutor'>
	        </div>
	        <div class="star">*</div>
	    </div>
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">被告名称</label>
	        <div class="ipt_area">
	            <input class="white_border placeholder_text_999999" type="text" placeholder="请填写被告名称" ng-model='accused'>
	        </div>
	        <div class="star">*</div>
	    </div>
	    
	   
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">案由</label>
	        <div class="ipt_area">
	            <div class="wrapper one no_border">
	                <select ng-model="describeCase" ng-options="type.name as type.name for type in causeActionList">
	                   <option value="">--请选择--</option>
	                </select>
	                <span class="triangle"></span>
	            </div>
	        </div>
	        <div class="star">*</div>
	    </div>
	    
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">案件进展 </label>
	        <div class="ipt_area">
	            <input class="white_border placeholder_text_999999" type="text" placeholder="请填写目前案件进展情况" ng-model='caseProgress'>
	        </div>
	        <div class="star">*</div>
	    </div>
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">索赔金额</label>
	        <div class="ipt_area">
	            <input class="white_border placeholder_text_999999" type="number" placeholder="请填写索赔金额" ng-model='claimAmt'>
	        </div>
	        <div class="star">*</div>
	    </div>
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">以往索赔</label>
	        <div class="ipt_area">
	            <input class="white_border placeholder_text_999999" type="number" placeholder="请填写以往同类案件获赔金额" ng-model='oldClaimAmt'>
	        </div>
	        <div class="star">*</div>
	    </div>
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">本案获赔</label>
	        <div class="ipt_area">
	            <input class="white_border placeholder_text_999999" type="number" placeholder="请填写本案预计获赔金额" ng-model='thisClaimAmt'>
	        </div>
	        <div class="star">*</div>
	    </div>
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">管辖法院地</label>
	        <div class="ipt_area">
	            <div class="wrapper">
	                <select id="province" ng-model="provinceName1" ng-options="o.province for o in provinceData" ng-change="clickCity(provinceName1,'1')">
	                    <option value="">选择省</option>
	                </select>
	                <span class="triangle"></span>
	            </div>
	            <div class="wrapper">
	                <select id="city" ng-model="cityName1" ng-options="o.city for o in cityData1" ng-change="clickArea(cityName1,'1')">
	                    <option value="">选择市</option>
	                </select>
	                <span class="triangle"></span>
	            </div>
	            <div class="wrapper">
	                <select id="county" ng-model="districtName1" ng-options="o.district for o in districtData1">
	                    <option value="">选择县</option>
	                </select>
	                <span class="triangle"></span>
	            </div>
	        </div>
	        <div class="star">*</div>
	    </div>
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">管辖法院名</label>
	        <div class="ipt_area">
	            <input class="white_border placeholder_text_999999" type="text" placeholder="请填写管辖法院名称" ng-model='obedientLawer'>
	        </div>
	        <div class="star">*</div>
	    </div>
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">拟结案期限</label>
	        <div class="ipt_area">
	            <div class="wrapper one no_border">
	                <select ng-model="closeDate" ng-options="id.name as id.name for id in closeCaseList">
	                    <option value="">--请选择--</option>
	                </select>
	                <span class="triangle"></span>
	            </div>
	        </div>
	        <div class="star">*</div>
	    </div>
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">投资总金额</label>
	        <div class="ipt_area">
	            <input class="white_border placeholder_text_999999" type="number" placeholder="请填写需投资总金额" ng-model='investAllAmt'>
	        </div>
	        <div class="star">*</div>
	    </div>
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">放款日期</label>
	        <div class="ipt_area">
	            <input class="white_border placeholder_text_999999" type="text" style='line-height: 38px;' placeholder="请填写期望放款日期" onfocus="(this.type='date')" ng-model='extendLoanDate'>
	        </div>
	        <div class="star">*</div>
	    </div>
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">收款银行名</label>
	        <div class="ipt_area">
	            <input class="white_border placeholder_text_999999" type="text" placeholder="请填写收款银行名称" ng-model='bankCardName'>
	        </div>
	        <div class="star">*</div>
	    </div>
	     <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">支行名称</label>
	        <div class="ipt_area">
	            <input class="white_border placeholder_text_999999" type="text" placeholder="请填支行名称" ng-model="branchName">
	        </div>
	        <div class="star">*</div>
	    </div>
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">账户名称</label>
	        <div class="ipt_area">
	            <input class="white_border placeholder_text_999999" type="text" placeholder="请填账户名称" ng-model="accountName">
	        </div>
	        <div class="star">*</div>
	    </div>
	    <div class="form_component minus_margin radius">
	        <label class="border bgColor121222">收款人账号</label>
	        <div class="ipt_area">
	            <input class="white_border placeholder_text_999999" maxlength=20 type="tel" placeholder="请填写收款人帐号" ng-model='bankCardNo'>
	        </div>
	        <div class="star">*</div>
	    </div>
	    <p class='top'>特别提示：以上金额单位为'元'</p>
    </div>
    <div class="sbt_bt_component" ng-click="goNext()">
        <div>下一步</div>
    </div>
</div>